Background Guidelines on the management of orally anticoagulated patients are continuously evolving, leading to an increased need for pharmacists to be fully integrated in care provision. Objective To identify self-reported gaps in confidence among practicing pharmacists in the area of anticoagulation. Setting Pharmacists in different work settings in different countries. Method Cross-sectional international survey from October 2015 till November 2016 among pharmacists working in different settings to assess their level of confidence when delivering anticoagulants as well as to identify possible educational needs regarding this medication class. Validation of the survey was ensured. Results Responses from 4212 pharmacists originating from 18 countries were obtained. Pharmacists' level of confidence was significantly higher (p < 0.001) when advising patients on vitamin K antagonists (VKAs) versus non-vitamin K antagonists (NOACs). In general, hospital pharmacists displayed higher confidence levels compared to community pharmacists when advising patients on anticoagulation (p < 0.001). Two distinct patterns of confidence levels emerged relating to basic and advanced pharmaceutical care. Confidence levels when providing advanced pharmaceutical care were significantly higher for Oceania and lower for South America (p < 0.005). Conclusions Pharmacists felt more confident in supporting patients receiving VKAs compared to the more recently introduced NOACs. With the increasing use of NOACs and the risks pertaining to anticoagulation therapy, it is essential to invest in education for pharmacists to address their knowledge gaps enabling them to confidently support patients receiving oral anticoagulants.

Barts Health Centre; Barts Health NHS Trust London UK

Centro de Investigação Interdisciplinar Egas Moniz Campus Universitário Quinta da Granja Monte da Caparica 2829 551 Caparica Portugal

College of Pharmacy Qatar University PO Box 2713 Doha Qatar

Department of Clinical Pharmacy Faculty of Pharmacy University of Szeged Szikrautca 8 Szeged 6724 Hungary

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles University Akademika Heyrovskeho 1203 500 05 Hradec Kralove Czech Republic

Farmacia Fernández Vega C B C Par nº 26 Urbanización Club de Golf Alcalá de Guadaira Sevilla 41500 Spain

Leslie Dan Faculty of Pharmacy University of Toronto Toronto ON M4J 1L2 Canada

Pharmaceutical Care Division Lange Leemstraat 187 2018 Antwerpen Belgium

Portuguese Pharmaceutical Society Rua da Sociedade Farmacêutica 18 1169 075 Lisboa Portugal

Research Group Clinical Pharmacology and Clinical Pharmacy Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Laarbeeklaan 101 1090 Brussels Belgium

School of Pharmacy University of Waterloo 755 Danforth Avenue Toronto ON M4J 1L2 Canada

Shoppers Drug Mart 1271 2501 3rd Line Oakville ON L6M 5A9 Canada

UCL Partners London UK

Int J Clin Pharm. 2018 Feb;40(1):202. doi: 10.1007/s11096-017-0586-4. PubMed

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